Cardio: Valvular insufficiencies Flashcards
concentric hypertrophy
aortic stenosis
Diastole sounds
S2 to S1 (Dub to lub)
stenosis
valve doesn’t open like it should
opening snap and progression of mitral stenosis
as it progresses it closer and closer to the second heart sound
Ejection - valves
Mitral closed, aortic open
most commonly heard murmur
holosystolic
what causes heart sounds
acceleration and deceleration of blood
Splitting of the second heart sound
inspiration slows pulmonic closure - we can percieve it as two sounds rather than one
Noise
unreated frequencies (eg: heart sounds) - no relationship between fundamental frequency and overtones
aortic area
right of sternum (left outflow track sounds are on the right)
what is the main cause of low viscosity in patients
anemia- low red cell concentration
pulmonary area
left of sternum in 3rd interspace (right outflow sounds are on the left of sternum)
Systole sounds
S1 to S2 (Lub to dub)
how do we normally hear 3rd and 4th Heart sound
with amplification - if we can hear them otherwise it ususally means something is wrong
Murmus in mitral stenosis
Opening sound, Early Diastolic murmur, Presystolic murmur
Separation Requirement
Must be by more than 25 msec to be perceived as two sounds (splitting of the second heart sound)
Aortic insufficiency
Diastolic lesion (heard in diastole) Eccentric hypertrophy (volume overload - heart pumps twice as much as normal)
Reynold Number
how we identify the liklihood of turbulence occuring (Re > 2000 = turbulence and murmurs )
Pulse and heart sounds
Upswing in pulse = Lub
2nd heart sound
aortic and pulmonic closure - can split (pulmonic is after aortic)
Filling - valves
aortic closed, mitral open
Tones
integral harmonics - related
insuffiecincy
doesn’t close like it should
Collapsing pulse (water-hammer)
some blood goes back across the valve . Rapid diastolic run off, ejection against low preload (jerky pulse - full and then collapses, full and then collapses)
severe mitral stenosis
no contraction of atria due to long cunduction pathway long term = pulmonary hypertension (end up with right and left sided lesion)
4th heart sound
Atria contract and get atrial kick- Atrial sound (not enough to hear it very well) - “gallop rhythm”
Diastolic lesions
occur in filling state of cardiac cycle = mitral stenosis and aortic insufficiency
Systolic defects
valvular state that ought to be present in systole = mitral insuficiency and aortic stenosis
Sound travels best through…
stiff structures
what causes high Reynold Number
when flow across valve is high and low viscosity and small diameter
Early diastole murmur
happens during rapid ventricular flow (high RE)
aortic stensosis (PV)
causes pressure overload (pressure axis gets tallker)
Anacrotic pulse
pulse rises very slowly- Aortic stenosis
excentric hypertrophy
insufficiencies - will widen the PV curve
3rd heart sound
rapid ventricular filling (mitral and tricuspid open) - first 1/3 of diastole. Sound from hitting the ventricular wall “Gallop rhythm” - normally don’t hear it (sometimes young adults)
RVE vs LVE
RVE starts first and ends last
1st heart sound
mitral and tricuspid closure
what pressures disturbed in mitral stenosis
atrial and ventricular pressures - as it progresses you get atrial distention
High heart rate
Systole and diastole moves to 50/50 rather then 1/3 to 2/3
Mitral stenosis progression
diastolic disorder ( we hear it during diastole)
Murmur cause
turbulent flow (nonlaminar flow)
mitral area
apical area in 5th interpace (left)
Auxillary mumor mitral insufficncy
occurs in DIASTOLE- much more rapid ventricular filling than usual due to regurgitation (high RN) = off cycle flow murmur
intensity on auscultation
high intesnity have high amplitude- easy to hear (moving large differences), shallow vibrations are less intense
regurgitation and incompetence
insufficienceys - blood blacks up because the valve didn’t close
Tricuspic valve
left lower sternal edge
Good attenuators (dampeners) in the body
Fat and inflated lungs
high frequency sound
low mass/elastance ratio
low frequency sound
high mass/elastance ratio
opneing sound (mitral valve stenosis)
snapping of the leaflet (snap) - slightly later than second heart sound and occurs on inspiration and expiration
Aortic stenosis murmur
Creciendo decreciendo murmur (up and down in intensity)
which lesion has no change in PV area
mitral valve stenosis
Duration of sound
How long was it? soft tissue attenuate (dampen) sound quickly
Mitral valve insuficiency
Systolic lesion (hear murmur during systole) MC murmur = holosystolic murmur . Eccentric hypertrophy (volume overload- like all insufficiencies)
which valves open in systole
mitral and atrial
holosystolic murmor
all through systolole starts after lub and continues to dub
Aortic stenosis
Systolic lesion. Disrupts relationship between aortic and ventricular pressure (tiny pin hole - have to try and push blood through) = Concentric hypertrophy - high pressure in aota
duration requirement
takes 1 s after onset to perceive full intensity (in heart sound time 60 bpm = lub every 1 second) = Never hearing them at full amplitude (brain cant keep up)
1st heart sound and mitral stenosis
gets louder and slightly delayed to QRS
Presystolic murmur
loose the atrial kick - atria distends in mitral stenosis
